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Rheumatology > Rheumatoid Arthritis > Flashcards

Rheumatoid Arthritis Flashcards

1
Q

Feature of rheumatoid arthritis

A

Symmetrical

Distal

Polyarthritis (>=5 joints)

EMS >1h

>6w of symptoms

Rheumatoid nodules

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2
Q

What is rheumatoid factor?

A

Anti-Fc portion antibodies

Always positive in patients with rheumatoid nodules

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3
Q

What are rheumatoid nodules?

A

Collections of macrophages/necrotic cells

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4
Q

X-ray features of rheumatoid arthritis

A

Osteopaenia, erosions, narrowing of joint space

Thumb subluxation

Soft tissue swelling

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5
Q

Blood tests for RA

A

RF

Anti-CCP

CRP/ESR

FBC (anaemia of chronic disease, thrombocytosis)

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6
Q

Presentation of rheumatoid

A

Onset over days-weeks

Preferentially affects wrist, MCP, PIP

May be palindromic (i.e. migratory) or acute (esp in women)

Consider in patients with recurrent soft-tissue problems (e.g. de Quervain’s, frozen shoulder, etc…)

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7
Q

Evaluation/workup for RA

A

FHx + cigarettes (F + F)

DAS28: Tender + swollen joint count, VAS, CRP/ESR

>5.1 severe, <2.6 remission

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8
Q

Early management of RA

A

Methylprednisolone IM depot 80-120mg > time to titrate DMARDs

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9
Q

Systemic extra-artiuclar features of RA

A

Fever

Weight loss

fatigue

Anaemia

Thrombocytosis

Amyloid

Splenomegaly

Lymphadenopathy

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10
Q

Cardiovascular features of RA

A

Pericarditis

Coronary fvasculitis

Conduction abnormalities

Aortitis

Accelerated atherosclerosis + IHD

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11
Q

Neurological features of RA

A

Cervical cord compression

Mononeuritis multiplex

Compression neuropathy (eg carpal tunnel)

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12
Q

Pulmonary features of RA

A

Nodules

Fibrosis

Effusions

Caplan’s syndrome (homoegenous nodules on X-ray)

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13
Q

Poor prognostic features of RA

A

Systemic features

Early erosions

Insidious onset

Persistent activity >12mo

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14
Q

Conventional DMARDs for RA

A

Methotrexate + folate

Hydroxychloroquine

Sulphasalazine

Leflunomide

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15
Q

SE + monitoring for MTX

A

FBCs (myelosuppression)

LFTs (hepatitis)

Lungs (pneumonitis), must have pretreatment CXR

Not allowed in pregnancy or child-bearing men (Affects M/F fertility!)

Must be stopped 3mo before pregnancy

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16
Q

Hydroxychloroquine monitoring

A

Optician review for macular damage

No blood tests necessary!

Safe in pregnancy but NOT breastfeeding

17
Q

Sulphasalazine monitoring

A

Myelosuppression (FBC)

Hepatitis (LFTs)

Rash

18
Q

Leflunomide monitoring

A

FBC (myelosuppression)

Hepatitis (LFTs)

Diarrhoea

Teratogenic (M/F)

19
Q

Indications for biologics in RA

A

DAS >5.1

Failed two DMARDs (incl. methotrexate)

>6/12 illness

MUST DO CXR BEFORE FIRST-LINE

20
Q

1st-line biologics in RA

A

Anti-TNF

Infliximab

Adalimumab

Etanercept (decoy receptor)

MUST DO CXR to rule out TB

21
Q

2nd line biologics in RA

A

Rituximab (anti-CD20)

Abatacept (CTLA-4 fused with IgG; natural T-cell modulator)

Tocilizumab (anti-IL6R)

22
Q

Adverse SEs of biologics

A

Immunosuppression

Reactivation of TB/HBV - esp. anti-TNF

Worsening HF

23
Q

Ocular features of RA

A

Scleritis

Episcleritis

Keratoconjunctivitis sicca (dry eye disease)

24
Q

EULAR vs ACR criteria for RA

A

EULAR includes

  • ACPA,
  • !!CRP!!
  • counts joint involvement
  • has duration criterion
25
Q

Location of Heberden’s nodes

A

Bony swellings of OA

DIP

26
Q

Location of Bouchard’s nodes

A

Bony swellings in OA

PIP

27
Q

Type of PIP joint deformity

A
28
Q

Management of osteoarthritis

A

Exercise

Hot/cold packs

Paracetamol

NSAIDs

Temporary: intra-articular injections

Joint replacement if severe impact on quality of life

29
Q

What is Vaughan-Jackson syndrome

A

Disruption of extensor tendons of hand > rupture from ulnar to radial

Assoc w/ RA

30
Q

Pre-op investigation of RA patients

A

Cervical spine X-ray to check for involvement > guide airway management

Rheumatology (6 decks)

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